MEDICARE: DEMONK GREELY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1184095838
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEMONK GREELY

Provider Business Mailing Address
First Line	:	2404 FERRAND ST
Second Line	:	SUITE 23
City	:	MONROE
State	:	LA
Zip	:	71201-3234
Country	:	US
Telephone Number	:	318-323-0463
Fax Number	:	318-323-0465

Provider Business Practice Location Address
First Line	:	2404 FERRAND ST
Second Line	:	SUITE 23
City	:	MONROE
State	:	LA
Zip	:	71201-3234
Country	:	US
Telephone Number	:	318-323-0463
Fax Number	:	318-323-0465

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/07/2015
Last Update Date	:	10/08/2018

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Directions to “ DEMONK GREELY ” Practice Location

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